在新冠肺炎住院患者中使用 Janus 激酶抑制剂：系统评价与荟萃分析。
The use of Janus Kinase inhibitors in hospitalized patients with COVID-19: Systematic review and meta-analysis.
作者信息
Wijaya Indra, Andhika Rizky, Huang Ian, Purwiga Aga, Budiman Kevin Yonatan, Bashari Muhammad Hasan, Reniarti Lelani, Roesli Rully Marsis Amirullah
机构信息
Division of Hematology and Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin General Hospital, Bandung, Indonesia.
Division of Nephrology and Hypertension, Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin General Hospital, Bandung, Indonesia.
出版信息
Clin Epidemiol Glob Health. 2021 Jul-Sep;11:100755. doi: 10.1016/j.cegh.2021.100755. Epub 2021 May 2.
BACKGROUND
The evidence of using JAK inhibitors among hospitalized patients with COVID-19 is conflicting. The systematic review and meta-analysis aimed to address the efficacy of Janus Kinase (JAK) Inhibitors in reducing risk of mortality among hospitalized patients with COVID-19.
METHODS
Several electronic databases, including PubMed, EuropePMC, and the Cochrane Central Register of Controlled Trials, with relevant keywords "COVID-19″ AND ("JAK inhibitor" OR "Ruxolitinib" OR "Tofacitinib" OR "Fedratinib" OR "Baricitinib") AND ("Severe" OR "Mortality"), were used to perform a systematic literature search up to December 11, 2020. All studies pertinent to the predetermined eligibility criteria were included in the analysis. Our outcome of interest was all types of mortality, clinical improvement, and clinical deterioration. Dichotomous variables of our outcomes of interest were analyzed using Maentel-Haenszel formula to obtain odds ratios (ORs) and 95% confidence intervals (CI) with random-effects modeling regardless of heterogeneity.
RESULTS
Five studies with a total of 1190 patients and were included in this systematic review and meta-analysis. The use of JAK inhibitors was associated with a reduced risk of mortality (OR 0.51, 95% CI 0.28-0.93, P = 0.02; I: 7.8%, P = 0.354) and clinical improvement (OR 1.76, 95% CI 1.05-2.95, P = 0.032; I: 26.4%, P = 0.253). The use of JAK inhibitors was not associated with a reduced risk of clinical deterioration (OR 0.58, 95% CI 0.28-1.19, P = 0.136; I: 24.1%, P = 0.267).
CONCLUSION
The use of JAK inhibitors was significantly associated with a reduced risk of mortality, and clinical improvement in hospitalized patients with COVID-19.
背景
关于新冠病毒疾病（COVID-19）住院患者使用JAK抑制剂的证据存在矛盾。本系统评价和荟萃分析旨在探讨Janus激酶（JAK）抑制剂在降低COVID-19住院患者死亡风险方面的疗效。
方法
利用多个电子数据库，包括PubMed、EuropePMC和Cochrane对照试验中央注册库，使用相关关键词“COVID-19”以及（“JAK抑制剂”或“鲁索替尼”或“托法替布”或“非德拉替尼”或“巴瑞替尼”）以及（“严重”或“死亡率”），进行截至2020年12月11日的系统文献检索。所有符合预定纳入标准的研究均纳入分析。我们感兴趣的结局是所有类型的死亡率、临床改善和临床恶化。对于我们感兴趣的结局的二分变量，使用Mantel-Haenszel公式进行分析，以获得比值比（OR）和95%置信区间（CI），采用随机效应模型，不考虑异质性。
结果
五项研究共1190例患者被纳入本系统评价和荟萃分析。使用JAK抑制剂与降低死亡风险（OR 0.51，95%CI 0.28 - 0.93，P = 0.02；I²：7.8%，P = 0.354）和临床改善（OR 1.76，95%CI 1.05 - 2.95，P = 0.032；I²：26.4%，P = 0.253）相关。使用JAK抑制剂与降低临床恶化风险无关（OR 0.58，95%CI 0.28 - 1.19，P = 0.136；I²：24.1%，P = 0.267）。
结论
使用JAK抑制剂与降低COVID-19住院患者的死亡风险及临床改善显著相关。
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